European Spine Journal

, Volume 26, Issue 9, pp 2242–2257 | Cite as

National clinical guidelines for non-surgical treatment of patients with recent onset neck pain or cervical radiculopathy

  • Per KjaerEmail author
  • Alice Kongsted
  • Jan Hartvigsen
  • Alexander Isenberg-Jørgensen
  • Berit Schiøttz-Christensen
  • Bolette Søborg
  • Charlotte Krog
  • Christian Martin Møller
  • Christine Marie Bækø Halling
  • Henrik Hein Lauridsen
  • Inge Ris Hansen
  • Jesper Nørregaard
  • Karsten Juhl Jørgensen
  • Lars Valentin Hansen
  • Marie Jakobsen
  • Martin Bach Jensen
  • Martin Melbye
  • Peter Duel
  • Steffan W. Christensen
  • Tina Myung Povlsen



To summarise recommendations about 21 selected non-surgical interventions for recent onset (<12 weeks) non-specific neck pain (NP) and cervical radiculopathy (CR) based on two guidelines from the Danish Health Authority.


Two multidisciplinary working groups formulated recommendations based on the GRADE approach.


Twelve recommendations were based on evidence and nine on consensus. Management should include information about prognosis, warning signs, and advise to remain active. For treatment, guidelines suggest different types of supervised exercise and manual therapy; combinations of exercise and manual therapy before medicine for NP; acupuncture for NP but not CR; traction for CR; and oral NSAID (oral or topical) and Tramadol after careful consideration for NP and CR.


Recommendations are based on low-quality evidence or on consensus, but are well aligned with recommendations from guidelines from North America. The working groups recommend intensifying research relating to all aspects of management of NP and CR.


Clinical guideline Neck pain Cervical radiculopathy Non-surgical intervention Recommendations Conservative treatment 



The authors would like to acknowledge the following members of the project groups and working groups: Karsten Junker, chairman CR working group, research librarians Herdis Foverskov, Kirsten Birkefoss and Conni Skrubbeltrang; lead reviewer Frank Lønberg; members of the working groups Hans Kristian Lauritsen, Jørgen Korsgaard, Peter Kryger-Baggesen, and Anne Gram.

Compliance with ethical standards


Funding was provided by The Danish Finance Act in 2012, and the DHA was commissioned to formulate the national clinical guidelines based on this. A salary was provided to members of the project groups, i.e., lead reviewers (AK, PK, and FL), project managers (BH and CH), methodologists (KJJ, MJ, and TP), search specialists, and chairmen. The funders had no role in the design, collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the article for public No funding was provided to the working or reference group members.

Conflicts of interest

Potential conflicts of interest have been declared by all involved partners and made publicly available on the DHA webpage (in Danish) [18].

Supplementary material

586_2017_5121_MOESM1_ESM.pdf (1.3 mb)
Supplementary material 1 (PDF 1317 kb)


  1. 1.
    Guyatt GH, Oxman AD, Kunz R, Atkins D, Brozek J, Vist G, Alderson P, Glasziou P, Falck-Ytter Y, Schunemann HJ (2011) GRADE guidelines: 2. Framing the question and deciding on important outcomes. J Clin Epidemiol 64:395–400. doi: 10.1016/j.jclinepi.2010.09.012 CrossRefPubMedGoogle Scholar
  2. 2.
    Qaseem A, Forland F, Macbeth F, Ollenschlager G, Phillips S, van der Wees P, Board of Trustees of the Guidelines International N (2012) Guidelines International Network: toward international standards for clinical practice guidelines. Ann Intern Med 156:525–531. doi: 10.7326/0003-4819-156-7-201204030-00009 CrossRefPubMedGoogle Scholar
  3. 3.
    Sundhedsstyrelsen (2016) National clinical guideline for the non-surgical treatment of recent onset non-specific neck pain. Danish Health Authority, Copenhagen SGoogle Scholar
  4. 4.
    Sundhedsstyrelsen (2015) National clinical guideline for the non-surgical treatment of recent onset nerve root compromise in the neck with symptoms radiating to the arm (cervical radiculopathy). Danish Health Authority, Copenhagen S, DenmarkGoogle Scholar
  5. 5.
    Fejer R, Kyvik KO, Hartvigsen J (2006) The prevalence of neck pain in the world population: a systematic critical review of the literature. Eur Spine J 15:834–848. doi: 10.1007/s00586-004-0864-4 CrossRefPubMedGoogle Scholar
  6. 6.
    Woods BI, Hilibrand AS (2015) Cervical radiculopathy: epidemiology, etiology, diagnosis, and treatment. J Spinal Disord Tech 28:E251–E259. doi: 10.1097/BSD.0000000000000284 CrossRefPubMedGoogle Scholar
  7. 7.
    Bono CM, Ghiselli G, Gilbert TJ, Kreiner DS, Reitman C, Summers JT, Baisden JL, Easa J, Fernand R, Lamer T, Matz PG, Mazanec DJ, Resnick DK, Shaffer WO, Sharma AK, Timmons RB, Toton JF, North American Spine S (2011) An evidence-based clinical guideline for the diagnosis and treatment of cervical radiculopathy from degenerative disorders. Spine J 11:64–72. doi: 10.1016/j.spinee.2010.10.023 CrossRefPubMedGoogle Scholar
  8. 8.
    Rubinstein SM, Pool JJ, van Tulder MW, Riphagen II, de Vet HC (2007) A systematic review of the diagnostic accuracy of provocative tests of the neck for diagnosing cervical radiculopathy. Eur Spine J 16:307–319. doi: 10.1007/s00586-006-0225-6 CrossRefPubMedGoogle Scholar
  9. 9.
    Lee TH, Kim SJ, Lim SM (2013) Prevalence of disc degeneration in asymptomatic korean subjects. Part 2: cervical spine. J Korean Neurosurg Soc 53:89–95. doi: 10.3340/jkns.2013.53.2.89 CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Teresi LM, Lufkin RB, Reicher MA, Moffit BJ, Vinuela FV, Wilson GM, Bentson JR, Hanafee WN (1987) Asymptomatic degenerative disk disease and spondylosis of the cervical spine: MR imaging. Radiology 164:83–88. doi: 10.1148/radiology.164.1.3588931 CrossRefPubMedGoogle Scholar
  11. 11.
    Cohen SP (2015) Epidemiology, diagnosis, and treatment of neck pain. Mayo Clin Proc 90:284–299. doi: 10.1016/j.mayocp.2014.09.008 CrossRefPubMedGoogle Scholar
  12. 12.
    Thoomes EJ, Scholten-Peeters GG, de Boer AJ, Olsthoorn RA, Verkerk K, Lin C, Verhagen AP (2012) Lack of uniform diagnostic criteria for cervical radiculopathy in conservative intervention studies: a systematic review. Eur Spine J 21:1459–1470. doi: 10.1007/s00586-012-2297-9 CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Hoy DG, Protani M, De R, Buchbinder R (2010) The epidemiology of neck pain. Best Pract Res Clin Rheumatol 24:783–792. doi: 10.1016/j.berh.2011.01.019 CrossRefPubMedGoogle Scholar
  14. 14.
    DALYs GBD, Collaborators H (2016) Global, regional, and national disability-adjusted life-years (DALYs) for 315 diseases and injuries and healthy life expectancy (HALE), 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet 388:1603–1658. doi: 10.1016/S0140-6736(16)31460-X CrossRefGoogle Scholar
  15. 15.
    Flachs EM, Statens Institut fF, Sundhedsstyrelsen (2015) Sygdomsbyrden i Danmark: sygdomme. Sundhedsstyrelsen, KbhGoogle Scholar
  16. 16.
    Radhakrishnan K, Litchy WJ, O’Fallon WM, Kurland LT (1994) Epidemiology of cervical radiculopathy. A population-based study from Rochester, Minnesota, 1976 through 1990. Brain: J Neurol 117(Pt 2):325–335CrossRefGoogle Scholar
  17. 17.
    Sundhedsstyrelsen (2015) Model for udarbejdelse af Nationale Kliniske Retningslinjer: Metodehåndbogen Version 2.1. Danish Health Authority. Accessed 6 Jan 2017
  18. 18.
    Sundhedsstyrelsen (2016) Declarations of conflicts of interests: working group members. Danish Health Authority.} Accessed 27 April 2017
  19. 19.
    Sundhedsstyrelsen (2014) Specialevejledning for neurokirurgi, Sagsnr. 41012-14/26. In. SundhedsstyrelsenGoogle Scholar
  20. 20.
    Sundhedsstyrelsen (2015) Search strategies recent onset cervical radiculopathy. Danish Health Authority. Guidelines: Primary literature: Secondary literature: Accessed Dec 2015
  21. 21.
    Sundhedsstyrelsen (2016) Search strategies recent onset non-specific neck pain. Danish Health Authority. Guidelines: literature: Secondary literature: Accessed April 2016
  22. 22.
    Brouwers MC, Kho ME, Browman GP, Burgers JS, Cluzeau F, Feder G, Fervers B, Graham ID, Grimshaw J, Hanna SE, Littlejohns P, Makarski J, Zitzelsberger L, Consortium ANS (2010) AGREE II: advancing guideline development, reporting and evaluation in health care. CMAJ 182:E839–E842. doi: 10.1503/cmaj.090449 CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Shea BJ, Grimshaw JM, Wells GA, Boers M, Andersson N, Hamel C, Porter AC, Tugwell P, Moher D, Bouter LM (2007) Development of AMSTAR: a measurement tool to assess the methodological quality of systematic reviews. BMC Med Res Methodol 7:10. doi: 10.1186/1471-2288-7-10 CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Furlan AD, Malmivaara A, Chou R, Maher CG, Deyo RA, Schoene M, Bronfort G, van Tulder MW, Editorial Board of the Cochrane Back NG (2015) Updated Method Guideline for Systematic Reviews in the Cochrane Back and Neck Group. Spine (Phila Pa 1976) 40:1660–1673. doi: 10.1097/BRS.0000000000001061 CrossRefGoogle Scholar
  25. 25.
    Covicence [Online Software]. Covidence Team. Accessed 6 Jan 2017
  26. 26.
    Review Manager (RevMan) [Computer program] (2014) Version 5.3 In. Copenhagen: The Nordic Cochrane Centre, Cochrane CollaborationGoogle Scholar
  27. 27.
    MAGIGapp [Online Software]. Accessed 6 Jan 2017
  28. 28.
    GRADEpro [Online Software]. Accessed 6 Jan 2017
  29. 29.
    Guyatt G, Oxman AD, Kunz R, Brozek J, Alonso-Coello P, Rind D, Devereaux P, Montori VM, Freyschuss B, Vist G, Jaeschke R, Williams JW Jr, Murad MH, Sinclair D, Falck-Ytter Y, Meerpohl J, Whittington C, Thorlund K, Andrews J, Schunemann HJ (2011) GRADE guidelines 6: rating the quality of evidence-imprecision. J Clin Epidemiol. doi: 10.1016/j.jclinepi.2011.01.012 Google Scholar
  30. 30.
    Sundhedsstyrelsen (2015) Flowcharts of literature for recent onset cervical radiculopathy. Danish Health Authority. Accessed 6 Jan 2017
  31. 31.
    Sundhedsstyrelsen (2015) Supporting material: National clinical guideline for the non-surgical treatment of recent onset nerve root compromise in the neck with symptoms radiating to the arm (cervical radiculopathy). Danish Health Authority. Accessed 8 Jan 2017
  32. 32.
    Sundhedsstyrelsen (2016) Supporting material: National clinical guideline for the non-surgical treatment of recent onset non-specific neck pain. Danish Health Authority. Accessed 8 Jan 2017
  33. 33.
    Childs JD, Cleland JA, Elliott JM, Teyhen DS, Wainner RS, Whitman JM, Sopky BJ, Godges JJ, Flynn TW, American Physical Therapy A (2008) Neck pain: clinical practice guidelines linked to the international classification of functioning, disability, and health from the orthopedic section of the American Physical Therapy Association. J Orthop Sports Phys Ther 38:A1–A34. doi: 10.2519/jospt.2008.0303 CrossRefPubMedGoogle Scholar
  34. 34.
    North American Spine S (2010) Diagnosis and treatment of cervical radiculopathy from degenerative disorders. North American Spine Society (NASS), Burr Ridge (IL)Google Scholar
  35. 35.
    Cote P, Wong JJ, Sutton D, Shearer HM, Mior S, Randhawa K, Ameis A, Carroll LJ, Nordin M, Yu H, Lindsay GM, Southerst D, Varatharajan S, Jacobs C, Stupar M, Taylor-Vaisey A, van der Velde G, Gross DP, Brison RJ, Paulden M, Ammendolia C, David Cassidy J, Loisel P, Marshall S, Bohay RN, Stapleton J, Lacerte M, Krahn M, Salhany R (2016) Management of neck pain and associated disorders: a clinical practice guideline from the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. Eur Spine J 25:2000–2022. doi: 10.1007/s00586-016-4467-7 CrossRefPubMedGoogle Scholar
  36. 36.
    Traeger AC, Hubscher M, Henschke N, Moseley GL, Lee H, McAuley JH (2015) Effect of primary care-based education on reassurance in patients with acute low back pain: systematic review and meta-analysis. JAMA Intern Med 175:733–743. doi: 10.1001/jamainternmed.2015.0217 CrossRefPubMedGoogle Scholar
  37. 37.
    Hasenbring MI, Pincus T (2015) Effective reassurance in primary care of low back pain: what messages from clinicians are most beneficial at early stages? Clin J Pain 31:133–136. doi: 10.1097/AJP.0000000000000097 CrossRefPubMedGoogle Scholar
  38. 38.
    Derebery J, Giang GM, Gatchel RJ, Erickson K, Fogarty TW (2009) Efficacy of a patient-educational booklet for neck-pain patients with workers compensation: a randomized controlled trial. Spine (Phila Pa 1976) 34:206–213. doi: 10.1097/BRS.0b013e318193c9eb CrossRefGoogle Scholar
  39. 39.
    Hoving JL, Koes BW, de Vet HC, van der Windt DA, Assendelft WJ, van Mameren H, Deville WL, Pool JJ, Scholten RJ, Bouter LM (2002) Manual therapy, physical therapy, or continued care by a general practitioner for patients with neck pain. A randomized, controlled trial. Ann Intern Med 136:713–722 (pii: 05210-00006) CrossRefPubMedGoogle Scholar
  40. 40.
    Andersen LL, Saervoll CA, Mortensen OS, Poulsen OM, Hannerz H, Zebis MK (2011) Effectiveness of small daily amounts of progressive resistance training for frequent neck/shoulder pain: randomised controlled trial. Pain 152:440–446. doi: 10.1016/j.pain.2010.11.016 CrossRefPubMedGoogle Scholar
  41. 41.
    Akhter S, Khan M, Ali SS, Soomro RR (2014) Role of manual therapy with exercise regime versus exercise regime alone in the management of non-specific chronic neck pain. Pak J Pharm Sci 27:2125–2128PubMedGoogle Scholar
  42. 42.
    Dusunceli Y, Ozturk C, Atamaz F, Hepguler S, Durmaz B (2009) Efficacy of neck stabilization exercises for neck pain: a randomized controlled study. J Rehabil Med 41:626–631. doi: 10.2340/16501977-0392 CrossRefPubMedGoogle Scholar
  43. 43.
    Franca DL, Senna-Fernandes V, Cortez CM, Jackson MN, Bernardo-Filho M, Guimaraes MA (2008) Tension neck syndrome treated by acupuncture combined with physiotherapy: a comparative clinical trial (pilot study). Complement Ther Med 16:268–277. doi: 10.1016/j.ctim.2008.02.006 CrossRefPubMedGoogle Scholar
  44. 44.
    Helewa A, Goldsmith CH, Smythe HA, Lee P, Obright K, Stitt L (2007) Effect of therapeutic exercise and sleeping neck support on patients with chronic neck pain: a randomized clinical trial. J Rheumatol 34:151–158 (pii: 0315162X-34-151) PubMedGoogle Scholar
  45. 45.
    Rendant D, Pach D, Ludtke R, Reisshauer A, Mietzner A, Willich SN, Witt CM (2011) Qigong versus exercise versus no therapy for patients with chronic neck pain: a randomized controlled trial. Spine (Phila Pa 1976) 36:419–427. doi: 10.1097/BRS.0b013e3181d51fca CrossRefGoogle Scholar
  46. 46.
    Revel M, Minguet M, Gregoy P, Vaillant J, Manuel JL (1994) Changes in cervicocephalic kinesthesia after a proprioceptive rehabilitation program in patients with neck pain: a randomized controlled study. Arch Phys Med Rehabil 75:895–899. doi: 10.1016/0003-9993%2894%2990115-5 CrossRefPubMedGoogle Scholar
  47. 47.
    Cleland JA, Childs JD, McRae M, Palmer JA, Stowell T (2005) Immediate effects of thoracic manipulation in patients with neck pain: a randomized clinical trial. Man Ther 10:127–135. doi: 10.1016/j.math.2004.08.005 CrossRefPubMedGoogle Scholar
  48. 48.
    Gonzalez-Iglesias J, Fernandez-de-las-Penas C, Cleland JA, Alburquerque-Sendin F, Palomeque-del-Cerro L, Mendez-Sanchez R (2009) Inclusion of thoracic spine thrust manipulation into an electro-therapy/thermal program for the management of patients with acute mechanical neck pain: a randomized clinical trial. Man Ther 14:306–313. doi: 10.1016/j.math.2008.04.006 CrossRefPubMedGoogle Scholar
  49. 49.
    Gonzalez-Iglesias J, Fernandez-de-las-Penas C, Cleland JA, Gutierrez-Vega Mdel R (2009) Thoracic spine manipulation for the management of patients with neck pain: a randomized clinical trial. J Orthop Sports Phys Ther 39:20–27. doi: 10.2519/jospt.2009.2914 CrossRefPubMedGoogle Scholar
  50. 50.
    Pikula JR (1999) The effect of spinal manipulative therapy (SMT) on pain reduction and range of motion in patients with acute unilateral neck pain: a pilot study. J Can Chiropr Assoc 43:111–119PubMedCentralGoogle Scholar
  51. 51.
    Celenay ST, Akbayrak T, Kaya DO (2016) A comparison of the effects of stabilization exercises plus manual therapy to those of stabilization exercises alone in patients with nonspecific mechanical neck pain: a randomized clinical trial. J Orthop Sports Phys Ther 46:44–55. doi: 10.2519/jospt.2016.5979 CrossRefPubMedGoogle Scholar
  52. 52.
    Bronfort G, Evans R, Nelson B, Aker PD, Goldsmith CH, Vernon H (2001) A randomized clinical trial of exercise and spinal manipulation for patients with chronic neck pain. Spine (Phila Pa 1976) 26:788–797 (discussion 798–789) CrossRefGoogle Scholar
  53. 53.
    Mejuto-Vazquez MJ, Salom-Moreno J, Ortega-Santiago R, Truyols-Dominguez S, Fernandez-de-Las-Penas C (2014) Short-term changes in neck pain, widespread pressure pain sensitivity, and cervical range of motion after the application of trigger point dry needling in patients with acute mechanical neck pain: a randomized clinical trial. J Orthop Sports Phys Ther 44:252–260. doi: 10.2519/jospt.2014.5108 CrossRefPubMedGoogle Scholar
  54. 54.
    Birch S, Jamison RN (1998) Controlled trial of Japanese acupuncture for chronic myofascial neck pain: assessment of specific and nonspecific effects of treatment. Clin J Pain 14:248–255CrossRefPubMedGoogle Scholar
  55. 55.
    Ilbuldu E, Cakmak A, Disci R, Aydin R (2004) Comparison of laser, dry needling, and placebo laser treatments in myofascial pain syndrome. Photomed Laser Surg 22:306–311. doi: 10.1089/pho.2004.22.306 CrossRefPubMedGoogle Scholar
  56. 56.
    Irnich D, Behrens N, Gleditsch JM, Stor W, Schreiber MA, Schops P, Vickers AJ, Beyer A (2002) Immediate effects of dry needling and acupuncture at distant points in chronic neck pain: results of a randomized, double-blind, sham-controlled crossover trial. Pain 99:83–89 (pii: S0304395902000623) CrossRefPubMedGoogle Scholar
  57. 57.
    Petrie JP, Hazleman BL (1986) A controlled study of acupuncture in neck pain. Br J Rheumatol 25:271–275CrossRefPubMedGoogle Scholar
  58. 58.
    Seidel U, Uhlemann C (2002) A randomised controlled double-blind trial comparing dosed lasertherapy on acupuncture points and acupuncture for chronic cervical syndrome. Deutsche Zeitschrift fur Akupunktur 45:258–269CrossRefGoogle Scholar
  59. 59.
    Thomas M, Eriksson SV, Lundeberg T (1991) A comparative study of diazepam and acupuncture in patients with osteoarthritis pain: a placebo controlled study. Am J Chin Med 19:95–100. doi: 10.1142/S0192415X91000156 CrossRefPubMedGoogle Scholar
  60. 60.
    White P, Lewith G, Prescott P, Conway J (2004) Acupuncture versus placebo for the treatment of chronic mechanical neck pain: a randomized, controlled trial. Ann Intern Med 141:911–919 (pii: 141/12/911) CrossRefPubMedGoogle Scholar
  61. 61.
    Witt CM, Brinkhaus B, Reinhold T, Willich SN (2006) Efficacy, effectiveness, safety and costs of acupuncture for chronic pain—results of a large research initiative. Acupunct Med 24:S33–S39CrossRefGoogle Scholar
  62. 62.
    Witt CM, Jena S, Brinkhaus B, Liecker B, Wegscheider K, Willich SN (2006) Acupuncture for patients with chronic neck pain. Pain 125:98–106. doi: 10.1016/j.pain.2006.05.013 CrossRefPubMedGoogle Scholar
  63. 63.
    Cho JH, Nam DH, Kim KT, Lee JH (2014) Acupuncture with non-steroidal anti-inflammatory drugs (NSAIDs) versus acupuncture or NSAIDs alone for the treatment of chronic neck pain: an assessor-blinded randomised controlled pilot study. Acupunct Med 32:17–23. doi: 10.1136/acupmed-2013-010410 CrossRefPubMedGoogle Scholar
  64. 64.
    Sherman KJ, Cherkin DC, Hawkes RJ, Miglioretti DL, Deyo RA (2009) Randomized trial of therapeutic massage for chronic neck pain. Clin J Pain 25:233–238. doi: 10.1097/AJP.0b013e31818b7912 CrossRefPubMedPubMedCentralGoogle Scholar
  65. 65.
    Predel HG, Giannetti B, Pabst H, Schaefer A, Hug AM, Burnett I (2013) Efficacy and safety of diclofenac diethylamine 1.16% gel in acute neck pain: a randomized, double-blind, placebo-controlled study. BMC Musculoskelet Disord 14:250. doi:  10.1186/1471-2474-14-250
  66. 66.
    Institut for RF (2011) N02B Svage analgetika: RekommandationGoogle Scholar
  67. 67.
    Institut for RF (2011) M01 og M09 NSAID, glukosamin og hyaluronsyre: RekommandationGoogle Scholar
  68. 68.
    Institut for RF (2011) N02A Opioider: RekommandationGoogle Scholar
  69. 69.
    Bronfort G, Evans R, Anderson AV, Svendsen KH, Bracha Y, Grimm RH (2012) Spinal manipulation, medication, or home exercise with advice for acute and subacute neck pain: a randomized trial. Ann Intern Med 156:1–10. doi: 10.7326/0003-4819-156-1-201201030-00002 CrossRefPubMedGoogle Scholar
  70. 70.
    Harboe KM, Jensen MP (2013) Akut uspecifikt lændehold. Rationel Farmakoterapi 2013Google Scholar
  71. 71.
    Lægemiddelstyrelsen (2000) Klinisk rationel smertebehandling. In. pp. 17 februar 2015.
  72. 72.
    Kay TM, Gross A, Goldsmith CH, Rutherford S, Voth S, Hoving JL, Bronfort G, Santaguida PL (2012) Exercises for mechanical neck disorders. Cochrane Database Syst Rev 8:CD004250. doi: 10.1002/14651858.CD004250.pub4 Google Scholar
  73. 73.
    Kuijper B, Tans JT, Beelen A, Nollet F, de Visser M (2009) Cervical collar or physiotherapy versus wait and see policy for recent onset cervical radiculopathy: randomised trial. BMJ 339:b3883. doi: 10.1136/bmj.b3883 CrossRefPubMedPubMedCentralGoogle Scholar
  74. 74.
    Ragonese J (2009) A randomized trial comparing manual physical therapy to therapeutic exercises, to a combination of therapies, for the treatment of cervical radiculopathy. Orthop Phys Ther Pract 21:71–76Google Scholar
  75. 75.
    McKenzie R, May S (2006) The cervical and thoracic spine: mechanical diagnosis and therapy, vol One. Waikanae Spinal Publications, New ZealandGoogle Scholar
  76. 76.
    BAPM (1966) Pain in the neck and arm: a multicentre trial of the effects of physiotherapy, arranged by the British Association of Physical Medicine. BMJ 1:253–258CrossRefGoogle Scholar
  77. 77.
    Fritz JM, Thackeray A, Brennan GP, Childs JD (2014) Exercise only, exercise with mechanical traction, or exercise with over-door traction for patients with cervical radiculopathy, with or without consideration of status on a previously described subgrouping rule: a randomized clinical trial. J Orthop Sports Phys Ther 44:45–57. doi: 10.2519/jospt.2014.5065 CrossRefPubMedGoogle Scholar
  78. 78.
    Jellad A, Ben Salah Z, Boudokhane S, Migaou H, Bahri I, Rejeb N (2009) The value of intermittent cervical traction in recent cervical radiculopathy. Ann Phys Rehabil Med 52:638–652. doi: 10.1016/ CrossRefPubMedGoogle Scholar
  79. 79.
    Young IA, Michener LA, Cleland JA, Aguilera AJ, Snyder AR (2009) Manual therapy, exercise, and traction for patients with cervical radiculopathy: a randomized clinical trial. Phys Ther 89:632–642. doi: 10.2522/ptj.20080283 CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  • Per Kjaer
    • 1
    • 2
    Email author
  • Alice Kongsted
    • 1
    • 2
    • 3
  • Jan Hartvigsen
    • 1
    • 3
  • Alexander Isenberg-Jørgensen
    • 4
  • Berit Schiøttz-Christensen
    • 5
    • 6
  • Bolette Søborg
    • 2
  • Charlotte Krog
    • 7
  • Christian Martin Møller
    • 8
  • Christine Marie Bækø Halling
    • 2
    • 9
  • Henrik Hein Lauridsen
    • 1
  • Inge Ris Hansen
    • 1
  • Jesper Nørregaard
    • 10
  • Karsten Juhl Jørgensen
    • 2
    • 11
  • Lars Valentin Hansen
    • 12
  • Marie Jakobsen
    • 2
    • 9
  • Martin Bach Jensen
    • 13
  • Martin Melbye
    • 14
  • Peter Duel
    • 15
  • Steffan W. Christensen
    • 16
    • 17
  • Tina Myung Povlsen
    • 2
    • 18
  1. 1.Department of Sports Science and Clinical BiomechanicsUniversity of Southern DenmarkOdense MDenmark
  2. 2.Evidence, Education and Emergency ServicesThe Danish Health AuthorityCopenhagen SDenmark
  3. 3.Nordic Institute of Chiropractic and Clinical BiomechanicsUniversity of Southern DenmarkOdense MDenmark
  4. 4.Centre for Spine Surgery and Research, Spine Centre of Southern DenmarkHospital LillebaeltMiddelfartDenmark
  5. 5.Spine Centre of Southern DenmarkHospital LillebaeltMiddelfartDenmark
  6. 6.Institute of Regional Health ResearchUniversity of Southern DenmarkOdense MDenmark
  7. 7.Københavns Fysioterapi I/SKøbenhavn ØDenmark
  8. 8.CFR HospitalerHellerupDenmark
  9. 9.KORAthe Danish Institute for Local and Regional Government ResearchCopenhagen KDenmark
  10. 10.Centre for Rheumatology and Spine DiseasesHillerødDenmark
  11. 11.The Nordic Cochrane CentreRigshospitaletCopenhagen ØDenmark
  12. 12.Spine Unit, Department of Ortopaedic SurgeryRigshospitaletCopenhagenDenmark
  13. 13.Research Unit for General Practice in Aalborg, Department of Clinical MedicineAalborg UniversityAalborg ØDenmark
  14. 14.Aalborg Spine ClinicAalborg RygklinikAalborgDenmark
  15. 15.Neurosurgical DepartmentAarhus University HospitalAarhus CDenmark
  16. 16.Department of Health Science and TechnologySMI®, Aalborg UniversityAalborgDenmark
  17. 17.Department of PhysiotherapyUniversity College of Northern Denmark (UCN)AalborgDenmark
  18. 18.Research and Test Center for Health Technologies. RigshospitaletGlostrupDenmark

Personalised recommendations